complaint·July 2, 2021

Staff reported they followed the protocol and sent R1 to hospital for evaluation and she was back to the facility on the same night because the hospital did not find any injury on R1. A couple days later, R1 felt very painful when staff tried to change her, and they immediately sent her to hospital again. The facility received a call from hospital and reported R1 had a hip fracture. Staff reported that’s the first time that R1 fell and R1 usually needs assistance from staff for transferring in an out from the bed. Staff reported sometimes R1 likes getting out from her bed by herself which R1 was not supposed to do that. In addition, LPA also interviewed residents in the facility from memory care unit and assisted living and all reported staff are able to meet their needs and they take good care of them. Based on interviews conducted and documents obtained the above allegation is determined to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted. Copy of report signed and given to Director of Health Services, Minerva Naranjo LPA interviewed staff and admitted they forgot to send the hearing aids for R1 while staff were rushed sending R1 to the hospital due to emergency. The staff did not attempt to send the hearing aids to R1 or contact the family for picking up while they found out R1’s hearing aids were not sent with resident. The family had to pick up the hearing aids from the facility and delivered them to R1 at the hospital. Besides that, R1 was not able to express well about her health concerns or needs with the hospital staff while she was at the emergency and hospital. Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED.. The deficiency is being cited on the attached LIC 9099D. Exit interview held and a copy of the report and appeal rights were provided to Director of Health Services, Minerva Naranjo